Has anyone ever reported SSI fraud on a patient?

MoopleRN · May 19, 2013

SSI fraud? Whaaaaaaat? Sliding Scale Insulin???????? Huh? Yes, It's late and I'm tired/waiting for the dryer to be done with the umpteenth load before bed... and I still don't understand how a patient could provide "too much information that would violate HIPPA".....?

xoemmylouox, ASN, RN · May 19, 2013

Well that is a new one for me. I wouldn't give out too much detail on here.. Hopefully someone on the board can be of some help. I will say I feel this way about some of the Medicaid patients we see. They use different addresses, don't report others who live in their homes, etc. it's frustrating.

Jory, MSN, APRN, CNM · May 19, 2013

I know I see it all the time, and it is starting to get ridiculous. I am nervous about reporting patients due to providing too much information that would violate HIPPA. Need advise and input on reporting SSI fraud on patients!

Reporting someone for a felony doesn't violate HIPAA. That is an obvious exception.

xoemmylouox, ASN, RN · May 19, 2013

Reporting someone for a felony doesn't violate HIPAA. That is an obvious exception.

Are you sure?? I think that unless you are VERY careful about details you might be in violation. If you decide to pursue this perhaps talk with a lawyer that has a hx with HIPAA.

roser13, ASN, RN · May 19, 2013

Reporting someone for a felony doesn't violate HIPAA. That is an obvious exception.

I'm not sure that I believe this. Yes, they're both federal entities/laws, but I imagine that the HIPAA enforcers wouldn't hesitate to rule that PHI is PHI, whether a crime is being committed or not.

OP, I hope that someone comes along who has knowledge of the issue. I know there are alot of us who see SSDI fraud on a routine basis and would like to know how to legitimately report the abuse.

ChristineN, BSN, RN · May 19, 2013

I know I see it all the time and it is starting to get ridiculous. I am nervous about reporting patients due to providing too much information that would violate HIPPA. Need advise and input on reporting SSI fraud on patients![/quote']
Yeah, we used to see it occasionally at the one hospital I used to work. Illegal immigrants would come in with stolen social security cards and we would figure out they were stolen when the numbers matched another person already admitted in the hospital. We would just give them a fake number. I don't think anyone ever reported it though

pixiestudent2 · May 19, 2013

Are you allowed to do that? Aren't patients supposed to be honest with health care providers without fear of being reported?

brownbook · May 19, 2013

I don't know a lot about SSI... supplemental security income. I agree with sali22. Do you want ill people NOT getting medical care? You see them all the time? What are they in your clinic or hospital for? Are they drug seeking? Do they have chronic medical issues? Again do you want them in your community ill and NOT getting whatever medical care they need?

Are you, the tax payers, paying for treatment they could pay for themselves but they are cheating the system?

I believe SSI is issued through the social security administration. Perhaps you could ask them, visit or write a letter to your nearest social security center. Tell them you suspect fraud is there anyway, anywhere, to report it.

You could write or visit your local or state representative. Tell them your concerns. How, or to who, do you report suspected fraud?

MunoRN, RN · May 19, 2013

It's usually considered poor form to take advantage of the relationship you develop with a patient to report them to authorities. If a patient confided in you that they smoke pot, would you then report them to authorities? Aside from mandatory reportable issues and imminent risk of harm to the patient or others, reporting an SSI issue or other information that patient should assume is confidential is arguably poor Nursing ethics.

KelRN215, BSN, RN · May 19, 2013

It's usually considered poor form to take advantage of the relationship you develop with a patient to report them to authorities. If a patient confided in you that they smoke pot, would you then report them to authorities? Aside from mandatory reportable issues and imminent risk of harm to the patient or others, reporting an SSI issue or other information that patient should assume is confidential is arguably poor Nursing ethics.

I agree. If you come across this information through your professional relationship with the person, it seems to me that it would be unethical to report it. We have a duty to breach patient confidentiality in very specific instances (such as the duty to warn or when child/elder abuse is suspected) but I do not believe the situation the OP describes would be one of them.

I imagine that in the course of his 16 years on the run, a healthcare professional or two came across Whitey Bulger. He says that he got his cardiac meds from Mexico but I find it hard to believe that an 83 year old man with cardiac problems never frequented a hospital during those years. So, assuming he did, no one ever reported him and he was on the FBI's most wanted list for many, many years.

morte, LPN, LVN · May 19, 2013

but, so is condoning fraud.

It's usually considered poor form to take advantage of the relationship you develop with a patient to report them to authorities. If a patient confided in you that they smoke pot, would you then report them to authorities? Aside from mandatory reportable issues and imminent risk of harm to the patient or others, reporting an SSI issue or other information that patient should assume is confidential is arguably poor Nursing ethics.